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[Editorial] Family planning: accelerating the way ahead  Voir?

The latest figures and progress of the Family Planning 2020 (FP2020) global partnership were released in its annual report on Dec 5. FP2020 The Way Ahead, together with a related research paper by Niamh Cahill and colleagues published online in The Lancet, paint a mixed picture. By July, 2017, more than 309 million women and girls of reproductive age in the 69 FP2020 focus (the world's poorest) countries are using modern methods of contraception. That figure is 38·8 million more than at the start of the FP2020 initiative in 2012.

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[Editorial] Putting research evidence at the heart of policy making  Voir?

To improve patient outcomes, research must inform and shape policy. As history sadly teaches, this ideal is not always realised. But in today's Lancet, two Articles display how research addressing knowledge gaps can inform policy for hypertension control in China.
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[Editorial] When a hospital becomes a prison  Voir?

Imprisonment for debt has a long history. In England during the 18th and 19th centuries, for instance, thousands of people were detained in debtors' prisons for failure to pay debts. Although such institutions no longer exist, in many parts of the world detention for unpaid debts is still a well known occurrence. Less recognised, however, is hospital detention—the practice of holding people in hospital against their will, not because their condition requires it, but because they have outstanding health-care bills.

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[Comment] Hypertension in China: the gap between policy and practice  Voir?

The high prevalence of hypertension in China is well known, with stroke being the most common cause of death and disability.1 Two large nationwide studies reported in The Lancet2,3 highlight that although the prevalence of hypertension in China is similar to that suggested in previous studies, it is simple deficiencies in the country's health system that make a large contribution to the disease burden. Both studies used data from the PEACE (Patient-Centred Evaluative Assessment of Cardiac Events) Million Persons Project (MPP), which enrolled 1·7 million adults aged 35–75 years from across China.

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[Comment] Childhood cancer: the long-term costs of cure  Voir?

Survival after childhood cancer has substantially improved over the past several decades, and more than 80% of children diagnosed with cancer in the USA now survive at least 5 years.1 This improvement comes at a cost, however, because the curative therapies used to achieve such successful survival proportions are associated with adverse late effects, with previous research finding increased risks of morbidity,2 poor health status,3 and premature mortality4 compared with sibling and population comparison groups.

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[Comment] The global fight against malaria is at crossroads  Voir?

Since 2000, millions of malaria deaths, especially among young children, have been averted in malaria-endemic countries with the unprecedented global investment in the fight against the disease.1 The malaria targets of the Millennium Development Goals for 2015 were achieved. Remarkably, this progress was reached by the imperfect application of imperfect tools. However, these gains may also have led to complacency about the worrying developments in recent years.

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[Comment] The mental health of refugees and asylum seekers on Manus Island  Voir?

On Oct 31, 2017, the Governments of Australia and Papua New Guinea ended support for the Manus Island Regional Processing Centre, an Australian immigration detention facility on Manus Island, Papua New Guinea. Instead, currently incomplete and substandard facilities without adequate service provision have been hastily constructed to accommodate people.1 379 refugees and asylum seekers refused to leave the centre stating fears for their security.2,3 They managed to survive for several weeks with no provision of food and water or electricity and in poor hygienic circumstances.

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[Comment] A new vision for global health leadership  Voir?

The complexity of global health problems demands leadership that represents the pluralism in society. The absence of gender parity in the leadership of key global health institutions in academic, governmental, and non-governmental organisations is evidence that this aspiration for diverse and inclusive leadership is not yet a reality.1,2 Women continue to represent most of the health workforce worldwide yet remain the minority in global health leadership.3 For example, only 31% of the world's ministers of health are women, and among the chief executives of the 27 health-care companies in the 2017 global Fortune 500, only one is female.

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[Comment] Offline: The tasks facing Dr Tedros  Voir?

Uncertainty is good. The fluidity that doubt brings can stimulate fresh thinking. Old assumptions discarded, orthodoxies dissolved, shibboleths erased. Unpredictability can be provocatively energising. WHO is currently undergoing such a period of creative instability. The draft 13th General Programme of Work (GPW) for 2019–23, presented to a Special Session of the Executive Board last month, was welcomed by member states as an ambitious new vision for the agency. But it also opened up a disruptive conversation about WHO's role and purpose.

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[World Report] Phage therapy: revival of the bygone antimicrobial  Voir?

The idea of using bacteriophages as vectors for antimicrobial therapy has existed for decades, but development towards clinical application still lags behind. Geoff Watts reports.
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[World Report] Millions in need of humanitarian assistance in Yemen  Voir?

The situation in Yemen—one of the world's worse humanitarian crises—risks deteriorating further. The death of Ali Abdullah Saleh might accelerate conflict. Sharmila Devi reports.
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[Perspectives] Qimin Zhan: driving medical research for better health in China  Voir?

“Clinical medicine + X”—the idea of integrating medicine with other disciplines—is at the heart of Qimin Zhan's vision for better health in China. As President of Peking University Health Science Centre (PUHSC) and Vice Chancellor of Peking University, he oversees five medical colleges, ten affiliated hospitals, and 14 teaching hospitals, and is committed to making this health system one of the world's leading medical centres. “We want to integrate medicine with disciplines like engineering, bioinformatics, nanotechnology, and big data to speed up the development of medical science”, says Qimin.

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[Perspectives] Hospital histories  Voir?

We never quite know what goes on behind closed doors. Hospitals are incubators for the most vital and vivid of human interactions. Much of these are secret and enclosed, sealed against the outside world. We are stripped down, as patients, wheeled on a trolley for surgery, our flawed and faulty bodies all we are left with. We become reliant on others to fulfil our basic bodily functions. Often dependant and frightened, patients are ministered to by staff, who also come with their own needs, anxieties, and dysfunctions.

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[Perspectives] Icarus  Voir?

When did the Middle Ages end? A traditional date is 1453, the fall of Byzantium. Another candidate is 1610, when Galileo reported that Jupiter had moons. But if a defining feature of the Middle Ages was transcendence—the belief that human beings are ultimately spiritual and that life on earth is a shadow of the heavenly life—then for some people, the Middle Ages ended with the collapse of great theocratic empires (Russia, China, the Ottoman Empire) and the advancement of secular politics.

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[Correspondence] Health-care delivery for long-term survivors of childhood cancer  Voir?

In their Article in The Lancet (Dec 9, p 2569),1 Bhakta and colleagues provide compelling data and novel statistical analysis to quantify the overwhelming lifetime cumulative burden of chronic health conditions caused by curative paediatric cancer therapies. As a 27-year survivor of Hodgkin's lymphoma, I applaud the authors' suggestion that it might be time to rethink the methods by which we provide care for long-term childhood cancer survivors. As a patient, I have had numerous encounters over the past three decades that have left me frustrated by the scarcity of easy access to coordinated comprehensive care for survivors.

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[Correspondence] Political determinants of Sustainable Development Goals  Voir?

We read with interest the article by the GBD 2016 SDG Collaborators1 (Sept 16, p 1423), which presents a comprehensive analysis of the potential gaps and gains in the health-related Sustainable Development Goals by 2030.
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[Correspondence] Anonymity in HIV testing: implications for public health  Voir?

To end the HIV epidemic, UNAIDS has set an ambitious target: by 2020, 90% of the people living with HIV will be diagnosed, 90% of those diagnosed will receive antiretroviral therapy (ART), and 90% of those receiving ART will be virally suppressed.1 The test and treat strategy will ensure care and treatment for almost 36·7 million people living with HIV, potentially saving millions of lives; however, the implementation of the strategy comes with multiple programmatic challenges.

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[Correspondence] Overestimation of cardiovascular outcome incidence  Voir?

We read with interest the study by Michael Böhm and colleagues (June 3, p 2226),1 in which they investigated the associations between blood pressure and cardiovascular outcomes and suggested that the lowest blood pressure possible is not the best goal for high-risk patients. Böhm and colleagues1 used Kaplan-Meier curves and Cox regression for the outcomes, stratified by different values of systolic blood pressure and diastolic blood pressure. However, because this study1 regards prediction of cardiovascular outcomes for patients, we caution about overestimation of the cumulative incidence of each outcome in the presence of competing events.

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[Correspondence] Overestimation of cardiovascular outcome incidence – Authors' reply  Voir?

We thank Yuanzi Ye and Ricardo Fonseca for their interest in our Article.1 We agree that the cumulative incidence of each outcome is slightly overestimated when the simple technique for calculating Kaplan-Meier curves is used instead of a more sophisticated method accounting for competing risks. However, the effect of overestimation is modest and, because it affects all strata simultaneously, the hazard ratios (HRs) between strata are nearly unchanged.

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[Correspondence] Antiplatelet cessation to manage bleeding events in elderly people  Voir?

In their Article in The Lancet, Linxin Li and colleagues (June 13, p 490)1 postulated that the increased risk of bleeding events with antiplatelet therapy in patients older than 75 years is sufficient to routinely prescribe proton-pump inhibitors (PPIs) in this group. This assumption is based on extrapolation from data showing the efficacy of PPIs in prevention of upper gastrointestinal bleeding in a younger population (mean age 68·4 years).2 What the authors do not consider is the opposite solution: cessation of antiplatelet therapy.

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[Correspondence] Antiplatelet cessation to manage bleeding events in elderly people – Authors' reply  Voir?

We agree with Cody Magnusson that little evidence exists to suggest that long-term use of aspirin in primary prevention of vascular events is effective in people older than 70 years. Indeed, we previously suggested that aspirin might be used for primary prevention of vascular events and cancer in people who are middle-aged,1,2 but should then be gradually withdrawn because of the high risk of bleeding at older ages. We await the results of the ASPREE trial,3 which should provide definitive evidence of the short-term benefits and harms of aspirin use in people older than 70 years.

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[Department of Error] Department of Error  Voir?

Lu J, Lu Y, Wang X, et al. Prevalence, awareness, treatment, and control of hypertension in China: data from 1·7 million adults in a population-based screening study (China PEACE Million Persons Project). Lancet 2017; 390: 2549–58—In figure 1 of this Article (published online first on Oct 25, 2017), the labels ‘Awareness’ and ‘Control’ should be swapped round. This correction has been made to the online version as of Nov 14, 2017, and the printed Article is correct.

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[Department of Error] Department of Error  Voir?

Pearson M, Metcalfe C, Jayamanne S, et al. Effectiveness of household lockable pesticide storage to reduce pesticide self-poisoning in rural Asia: a community-based, cluster-randomised controlled trial. Lancet 2017; 390: 1863–72—In this Article (published online first on Aug 11, 2017), Martin Wilks (Swiss Centre for Applied Human Toxicology, University of Basel, Switzerland) should have been cited in the Data Monitoring Committee. This correction has been made to the online version as of Dec 7, 2017.

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[Articles] Prevalence, awareness, treatment, and control of hypertension in China: data from 1·7 million adults in a population-based screening study (China PEACE Million Persons Project)  Voir?

Among Chinese adults aged 35–75 years, nearly half have hypertension, fewer than a third are being treated, and fewer than one in twelve are in control of their blood pressure. The low number of people in control is ubiquitous in all subgroups of the Chinese population and warrants broad-based, global strategy, such as greater efforts in prevention, as well as better screening and more effective and affordable treatment.

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[Articles] Availability, cost, and prescription patterns of antihypertensive medications in primary health care in China: a nationwide cross-sectional survey  Voir?

China has marked deficiencies in the availability, cost, and prescription of antihypertensive medications. High-value medications are not preferentially used. Future efforts to reduce the burden of hypertension, particularly through the work of primary health-care providers, will need to improve access to, and use of, antihypertensive medications, paying particular attention to those with high value.

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[Articles] The cumulative burden of surviving childhood cancer: an initial report from the St Jude Lifetime Cohort Study (SJLIFE)  Voir?

The burden of CHCs in survivors of childhood cancer is substantial and highly variable. Our assessment of total cumulative burden in survivors of paediatric cancer, with detailed characterisation of long-term CHCs, provide data to better inform future clinical guidelines, research investigations, and health services planning for this vulnerable, medically complex population.

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[Clinical Picture] Vanishing lung syndrome: giant bullous emphysema  Voir?

A 44-year-old man with a 17-year history of tobacco and cannabis use presented to the emergency department with acute dyspnoea and left-sided pleuritic chest pain. He had no other medical conditions and took no regular medications. On examination he was thin and hypoxic, with a silent, hyper-resonant left hemithorax. Chest radiograph showed a large left upper lobe bulla (figure), and an incidental air rifle pellet. He was given pulmonary rehabilitation, started on regular inhaled therapy with regular tiotropium and budesonide-formoterol and salbutamol as required, and given smoking cessation support.

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[Review] The primary health-care system in China  Voir?

China has made remarkable progress in strengthening its primary health-care system. Nevertheless, the system still faces challenges in structural characteristics, incentives and policies, and quality of care, all of which diminish its preparedness to care for a fifth of the world's population, which is ageing and which has a growing prevalence of chronic non-communicable disease. These challenges include inadequate education and qualifications of its workforce, ageing and turnover of village doctors, fragmented health information technology systems, a paucity of digital data on everyday clinical practice, financial subsidies and incentives that do not encourage cost savings and good performance, insurance policies that hamper the efficiency of care delivery, an insufficient quality measurement and improvement system, and poor performance in the control of risk factors (such as hypertension and diabetes).

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[Review] China's Silk Road and global health  Voir?

In 2013, China proposed its Belt and Road Initiative to promote trade, infrastructure, and commercial associations with 65 countries in Asia, Africa, and Europe. This initiative contains important health components. Simultaneously, China launched an unprecedented overseas intervention against Ebola virus in west Africa, dispatching 1200 workers, including Chinese military personnel. The overseas development assistance provided by China has been increasing by 25% annually, reaching US$7 billion in 2013.

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[Viewpoint] The need for a complex systems model of evidence for public health  Voir?

Despite major investment in both research and policy, many pressing contemporary public health challenges remain. To date, the evidence underpinning responses to these challenges has largely been generated by tools and methods that were developed to answer questions about the effectiveness of clinical interventions, and as such are grounded in linear models of cause and effect. Identification, implementation, and evaluation of effective responses to major public health challenges require a wider set of approaches1,2 and a focus on complex systems.

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Dernière mise à jour : 13/12/2017 : 19:33


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